Provider Demographics
NPI:1710085006
Name:RATHJE, RONALD SCOTT (LCSW)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:SCOTT
Last Name:RATHJE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:R
Other - Middle Name:SCOTT
Other - Last Name:RATHJE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33831-1559
Mailing Address - Country:US
Mailing Address - Phone:863-519-0575
Mailing Address - Fax:863-582-9251
Practice Address - Street 1:1825 GILMORE AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3017
Practice Address - Country:US
Practice Address - Phone:863-519-0575
Practice Address - Fax:863-248-3302
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0008592104100000X
FLSW148801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000359775OtherANTHEM
000000359775OtherANTHEM
RASW25241Medicare PIN